[The analysis of the clinical symptoms and social conditionings of the tic disorder in children]. / Analiza przebiegu klinicznego oraz uwarunkowan spolecznych tików u dzieci.

UNLABELLED: A tic is a rapid, involuntary and stereotypical motor movement or vocalization. The exact cause of tic disorder is unknown, but it is well established that both genetic and environmental factors are involved. Tic occurence in population was estimated on 5-100/10 000. AIM: The purpose of the research was to analyze the clinical symptoms and social conditionings of tic disorder in children. MATERIAL AND METHOD: The analysis was conducted on a group of 42 patients (8 girls, 34 boys) at the age of 3 to 15 years, admitted to Department of Neuropediatric of Medical University of Silesia to diagnose and treatment of tic disorder. The children's family history was analyzed. The patients were physically, neurogically, radiologically and psychologically examined. RESULTS: The majority group were boys and the time of the symptoms appearance was an early school age. The tics were associated with emotional and anxiety disorders, compulsive behavior, psychological obsession. 9% of patients had family history of tic disorder. Pregnancy-birth history was complicated in 24% of cases. There were not abnormalities in physical, neurological and radiological examination in most cases. The majority group (83%) lives in the cities. The most parents have vocational training. CONCLUSION: In case of appearance of twitching during suspicious behavior of child, we need to carry out a inquiring research targeted to widely understated social issues.

[Situation-related seizures in patients at developmental age]. / Napady sytuacyjne u pacjentów w wieku rozwojowym.

The seizures which accompany specified situations occur in about 5% of population. They are frequent in patients at developmental age due to a different degree of brain maturity. A single, occasional seizure event which occurs in specified situations is not an epilepsy but it constitutes a significant clinical problem which requires a thorough diagnostics and procedure. We discuss situation-related seizures (also called acute symptomatic seizures) in children, excluding febrile convulsions. We bring attention to situation-related seizures characteristic only of developmental age.

Angelman syndrome revisited.

OBJECTIVES: Angelman syndrome (AS) is characterized by severe mental retardation, epilepsy, absent speech, dysmorphic facial features, and a characteristic behavioral phenotype. It is caused by deficiency of gene expression from maternally derived chromosome 15q11-q13. STUDY DESIGN: The authors present the clinical picture of 9 children (median age, 4.9 years; range, 1 to 10 years) with confirmed Angelman syndrome. The patients complied with the international consensus criteria for AS and were consecutively investigated for psychomotor development, epilepsy, and electroencephalogram (EEG) profiles. RESULTS: The median age at diagnosis was 3.9 years. The motor milestones were delayed. Median developmental quotient level was 26. All patients but 1 experienced predominantly polymorphic seizures. In 4 cases, the epilepsy was refractory to treatment. The EEG of all patients displayed an abnormal sleep pattern and generalized abnormalities, with a maximum over the posterior areas. CONCLUSIONS: Milder or less typical phenotypes of AS may remain undiagnosed, leading to an overall underdiagnosis of the disease. The EEG shows no clear relation to genotype, clinical picture, or to the presence and severity of epilepsy. AS should be considered in the differential diagnosis of children with severe cryptogenic epilepsy and a characteristic configuration of clinical features.

[Diagnostic problems with long QT syndrome in 5-year-old boy]. / Trudnosci diagnostyczne w rozpoznaniu zespolu wydluzonego QT u 5-letniego chlopca.

The authors described the case of 5-year-old boy, in whom a proper diagnosis was established after 19 months. In differential diagnosis, epileptic, tetanic and conversion seizures were taken into consideration.

[Vasovagal syncope--diagnostic difficulties in adolescents]. / Omdlenia wazowagalne--trudnosci diagnostyczne u mlodziezy.

Consciousness disturbances in adolescents may be caused by different reasons. Among them, cardiologic and neurological backgrounds should be considered. The most important diagnostic tests the vasovagal syncopes are: tilt-table test, brain oxygenation measurement, routine and extended elektroencephalography. Performing of these examinations simultaneously may help in determining cause of symptoms. Our patient serves us as an example.

[Treatment termination in children with idiopathic generalized epilepsy and cryptogenic focal epilepsy]. / Zakonczenie terapii u dzieci z idiopatyczna padaczka uogólniona i kryptogenna padaczka ogniskowa.

The regression of epileptic attacks after a period for remission brings hope, particularly for a sick child's parents, for prompt treatment termination. This process, however, is related to the risk that the disease will recur. The paper is about the evolution of these changes in EEG and the assessment of disease recurrence in the course of treatment and upon therapy termination in patients taking valproic acid preparations (VPA) during idiopathic generalized epilepsy (IGE) and those taking carbamazepine (CBZ) preparations during cryptogenic focal epilepsy (CFE). A total of 121 patients in whom the attacks regressed as a result of monotherapy, were subjected to the assessment. The patients were classified into 2 groups: the first group of 52 patients treated with VPA (IGE), patients' age at the beginning of treatment--from 6 to 14, and the second group of 69 patients treated with CBZ (CFE), patients' age at the beginning of treatment--from 5 to 12. In patients suffering from IGE, an absence of attacks prevailed; while in those with CFE--the secondary generalized ones prevailed. The drug dosage reduction lasted from 3 to 24 months. The observation time at treatment termination was 2 years. 10 routine EEG tests were assessed in each patient. Attack regression was achieved mainly within 2 weeks, sporadically up to 6 months. In the initial EEG tests 4 (5.8%) of the patients with partial seizures had normal records, in the remaining 94.2%--the records were abnormal. Throughout the duration of the treatment, systematic improvement of EEG was noted in groups 1 and 2. At the commencement of the dosage reduction, the EEG irregularities were maintained in 9% of the patients with IGE and in 26% of those with CFE, increasing during reduction until the discontinuance of the medication. Frequency of attack recurrences was twice as large in the patients with IGE (mainly after the end of treatment) than in those with CFE, where they occurred during the reduction period and up to 3 months after the end of treatment. The recurrence of the disease in children of the first group was only preceded in one third by irregularities in EEG; on the contrary, it occurred in two thirds of the second group. The morphology of changes was non-homogeneous.

[Nonepileptic seizures of psychogenic origin in children: analysis and characteristics of risk factors, clinical symptoms and significance of diagnostic investigation]. / Rzekomopadaczkowe napady pochodzenia psychogennego u dzieci--analiza i charakterystyka czynników ryzyka, obrazu klinicznego i wartosci badan dodatkowych.

Nonepileptic seizures of psychogenic origin (NESP) belong currently to dissociation disorders. Their causes and precise outline of diagnostics, therapy and prophylaxis procedures remains still difficult. The authors investigated the group that consisted of 25 patients with the above described type of seizures. Prospective examinations were conducted. In each patient detailed analysis of risk factors and clinical semiology before and after hospital admission was performed. Moreover brain MRI, psychological and psychiatric examinations were made. Among patients with NESP, girls prevailed (88%). Most important stressogenic factor was trouble with peer relationships. Clinical manifestation was diverse, mostly the attacks were similar to epileptic, simple, partial seizures. The final diagnosis depended on results of video examinations (lack of clinical-bioelectrical correlation or lack of bioelectrical activity disturbances before or after attack) and results of psychological and psychiatric consultation.

Headaches as somatoform disorders in children and adolescents.

Somatoform disorders are often the main cause for seeking professional advice and performing a number of specialist checks. The aim of the study was to determine the frequency of somatoform disorders in the form of headaches in children and adolescents neurologically diagnosed and the risk factors thereof. Analysis of the biological and situational risk factors were established. Somatoform disorders were diagnosed in 27 out of 276 children with headaches. We concluded that in the differential diagnosis of headaches, somatoform headaches should not be omitted as every 10(th) patient in the developmental age diagnosed on the neurological ward because of headache shows signs of somatoform headaches. In diagnostically difficult cases it is recommended that analysis of biological and situational risk factors be performed with special attention paid to chronic disease of the patient and/or in his immediate family, the patient's psychological disorders and dysfunctional or low social status families. The creation of separate criteria for somatoform disorders of the developmental age should be considered.